Coronary Disease ; surgery ; Drug-Eluting Stents

China ; Coronary Artery Bypass ; methods ; Coronary Artery Disease ; surgery ; Humans

Coronary Artery Disease ; surgery ; Humans ; Mitral Valve Stenosis ; surgery

Humans ; Infant ; Mucocutaneous Lymph Node Syndrome/surgery* ; Coronary Artery Bypass/adverse effects* ; Coronary Aneurysm/surgery* ; Coronary Artery Disease/surgery*

BACKGROUNDIn patients with chronic total occlusion (CTO) and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent (DES) implantation with coronary artery bypass surgery (CABG) in the patients with CTO and multivessel disease.

METHODSFrom a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG (n = 679) or DES (n = 267) treatment. Their propensity risk score was used for adjusting baseline differences.

RESULTSAt a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events (MACCE) was lower in CABG group (12.7% vs. 24.3%, hazard ratio (HR) 1.969, 95%CI 1.219 - 3.179, P = 0.006) mainly due to lower rate of target vessel revascularization in CABG group than in DES group (3.1% vs. 17.2%, HR 16.14, 95%CI 5.739 - 45.391, P < 0.001). The incidence of cardiac death or myocardial infarction (composite end point) was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction (LVEF), and complete revascularization were identified as significant predictors of composite end points.

CONCLUSIONSOur study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.

Angioplasty, Balloon, Coronary ; methods ; Chronic Disease ; Coronary Angiography ; Coronary Artery Bypass ; methods ; Coronary Artery Disease ; surgery ; therapy ; Coronary Occlusion ; surgery ; therapy ; Drug-Eluting Stents ; Humans ; Prospective Studies

OBJECTIVETo evaluate the safety and efficacy of exercise rehabilitation in coronary heart disease patients post reascularization procedure.

METHODWe searched the Cochrane Central Register of Controlled Trials (CCRCT), Pubmed, Wanfang, CNKI, CBM and VIP database for randomized controlled trials (RCTs) on exercise rehabilitation for patients with coronary artery disease post percutaneous coronary intervention revascularization or coronary artery bypass grafting. Quality assessment and data collection were conducted by two reviewers independently. The data were analyzed by Review Manager 5.0.

RESULTSA total of 3 474 patients from 16 RCTs were included in this meta-analysis and patients were divided into exercise rehabilitation group (n = 1 425) and control group (n = 2 049). Meta-analysis results showed mortality rate was similar between the two groups (OR = 0.81, 95%CI 0.38-1.69, P > 0.05) and the incidence of major cardiovascular events rate (OR = 0.40, 95%CI 0.24-0.65, P < 0.01) and heart rate [mean difference (MD) = -2.82, 95%CI -4.72--0.92, P < 0.01] were significantly lower while LVEF (MD = 2.24, 95%CI 0.18-4.31, P < 0.05), the exercise metabolic equivalent (MD = 0.94, 95%CI 0.43-1.44, P < 0.01) , anaerobic threshold (MD = 1.83, 95%CI 0.67-3.00, P < 0.01) , and maximum oxygen consumption (MD = 3.22, 95%CI 2.42-4.03, P < 0.01) were significantly higher in exercise rehabilitation group than in control group.

CONCLUSIONExercise rehabilitation does not increase the risk of mortality in patients of coronary heart disease after revascularization and can effectively reduce major cardiovascular events.

Coronary Artery Bypass ; Coronary Disease ; rehabilitation ; surgery ; Exercise Therapy ; Humans ; Percutaneous Coronary Intervention ; Treatment Outcome

OBJECTIVETo compare graft patency in off-pump and conventional coronary artery bypass grafting by using the transit time flow meter in the treatment of triple vessel coronary artery disease.

METHODSBetween June 2000 and April 2001, 60 patients with triple vessel coronary artery disease underwent coronary artery bypass grafting. They were divided into two groups: off-pump and conventional coronary artery bypass. All completed grafts were tested intraoperatively using Transit Time Flow Measurement (TTFM). Preoperative and postoperative variables of the two groups were also compared.

RESULTSThere were no significant differences in sex, age, weight, acute or remote myocardial infarction, hypertension, diabetes and type of bypass grafts between the two groups. The number of bypass grafts and the assisted respiratory time of the off-pump coronary artery bypass grafting (OPCAB) group were significantly less than those of the conventional coronary artery bypass grafting (CCABG) group. The flow and pulsatile index (PI) of the left anterior descending artery bypass grafts and the right coronary artery bypass grafts were not significantly different between the OPCAB and CCABG groups. The flow of OM in the CCABG group with the multiple anastomosis site of sequential grafts was higher than that in the OPCAB group. Diffused narrow coronary artery bypass grafts in both groups had less flow.

CONCLUSIONNo significant differences in graft patency were observed in patients with triple vessel coronary artery disease who had undergone OPCAB or CCABG.

Aged ; Coronary Artery Bypass ; methods ; Coronary Circulation ; Coronary Disease ; physiopathology ; surgery ; Female ; Humans ; Male ; Middle Aged

OBJECTIVETo evaluate the long-term clinical outcomes of fractional flow reserve (FFR)-guided versus intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) for intermediate coronary lesions.

METHODSA total of 226 patients with 293 intermediate coronary artery lesions (stenosis of 40%-70%) confirmed by coronary angiography were randomized into 3 groups to undergo PCI for a minimal lumen cross sectional area (MLA)<4 mm(2) (IVUS group, 98 lesions) or for a FFR<0.80 (FFR group, 101 lesions), or to receive standard medical treatment (medication group, 94 lesions). The primary outcome was major adverse cardiac events including death, myocardial infarction, and ischemia-driven target vessel revascularization at 1 year after the index procedure.

RESULTSThe baseline percent diameter stenosis and lesion length were similar between the 3 groups, but more patients in IVUS group than in FFR group received PCI (P<0.001). No significant difference was found in the incidence of major adverse cardiac events between the 3 groups (P=0.182).

CONCLUSIONBoth FFR- and IVUS-guided PCI strategy for intermediate coronary artery disease are associated with favorable outcomes, but IVUS-guided PCI based on the single index of MLA can increase the rate of revascularization therapy.

Coronary Angiography ; Coronary Artery Disease ; surgery ; Fractional Flow Reserve, Myocardial ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention

China ; Coronary Angiography ; Coronary Artery Disease/surgery* ; Humans ; Percutaneous Coronary Intervention ; Treatment Outcome

Humans ; Coronary Artery Disease/surgery* ; Percutaneous Coronary Intervention ; Heart ; Treatment Outcome ; Coronary Angiography